Gastroenterology Coding Alert

Question: Our physician performed an EGD with biopsy before inserting a Maloney bougie dilator. He used fluoroscopic guidance during the procedure. How should I code this?


North Carolina Subscriber

Answer: No matter how you code this service, Medicare's multiple-procedure rules prohibit 100 percent reimbursement for all the procedures in this situation.

Report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) first because it has a higher relative value. You should receive full payment from Medicare for the esophagoscopy.

For the Maloney dilation, use 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes). For the fluoroscopy, use 74360-26 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and interpretation; professional component) for the physician's fluoroscopy interpretation. For both the dilation and fluoroscopy, you should expect reimbursement to be 50 percent of the standard fee. 

Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.